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PGY1 > Emergency Medicine 101 > Flashcards

Emergency Medicine 101 Flashcards

1
Q

Definition of syncope

A

sudden and transient LOC with loss of postural tone accompanied by rapid return to baseline

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2
Q

DDx for syncope

A

cardiac vs. non cardiac; cardiac: dysrhythmias, pacemaker issues, outflow obstruction (aortic stenosis, HOCM), MI, dissection, cardiomyopathy, PE; non-cardiac: reflex-mediated - vasovagal, orthostatic, situational, carotid massage/pressure, subclavian steal (arm exercises), medications (BB, CCB, digoxin, insulin; QT prolonging meds, drugs of abuse), focal CNS (hypoxia, epilepsy, dysfunctional brainstem)

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3
Q

Physical exam for syncope

A

cardiac + neuro

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4
Q

Investigation for syncope

A

ECG, CBC, lytes, extended, lytes, glucose, troponin, Cr,

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5
Q

Cardiac dysrhythmias associated with syncope

A

WPW, Brugada, heart block, QT prolongation, ARVD, HOCM

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6
Q

MGMT of syncope

A

General (ABCs, monitors, oxygen, IV access), cardio consult vs outpt cardiac, canadian syncope risk score

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7
Q

Definition of altered LOC

A

decreased LOC caused by CNS dysfunction (primary CNS vs. diffuse)

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8
Q

DDx of altered LOC

A

drugs: abuse - opiates benzos, BBs, TCA, ASA, acetaminophen, digoxin; environmental: carbon monoxide, cyanide; infectious: sepsis, meningitis/encephalitis, cerebral abscess; metabolic: hypogylcemia, electrolytes, uremia, kidney failure, hepatic encephalopathy, thyroid, DKA, HHS; structural: ICH, epidural hematoma, subdural hematoma, SAH, seizures, strokes, hydrocephalus, ACS, dissection, arrhythmias, shock

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9
Q

Physical exam for altered LOC

A

ABC, primary survey, temp and glucose, rapid neuro

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10
Q

Inv for altered LOC

A

CBC, lytes, glucose, Cr, urea, LFTs, INR/PTT, serum osmoles, VBG, troponin, tox screen; ECG, CXR, CT Head

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11
Q

MGMT for altered LOC

A

general, universal antidotes (oxygen, glucose, naloxine, thamine), ABx, BP control; dispo: admit for work-up

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12
Q

Migraine HA definition

A

“POUND” - pulsatile, onset of 4 - 72 hours, unilateral, N/V, disabling; photophobia/phonophobia, chronic, recurrent, +/- aura

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13
Q

Cluster HA definition

A

unilateral sudden sharp retro-orbital pain, < 3 hours, usually at night, pseudo-Horner’s, associated with smoking and alcohol

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14
Q

Tension HA definition

A

tight bandlike, tense neck and scalp, associated with stress/sleep

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15
Q

DDx for HA

A

primary (migraines, cluster, tension) vs. secondary: intracranial - bleed (epidural, subdural, SAH, intracerebral), infectious: meningitis, encephalitis, brain abscess; increased ICP (mass, cerebral venous sinus thrombosis); extra-cranial: AACG, temporal arteritis, carotid artery dissection, carbon monoxide poisoning

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16
Q

Red Flags for headaches

A

sudden onset, thunderclap, exertional, meningismus, fever, neurological deficit, AMS, ICP signs

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17
Q

Physical for HA

A

neuro, neck, eye exam

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18
Q

Investigation for HA

A

CT Head, LP if CT head negative but suspicious, ESR/CRP if temporal arteritis

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19
Q

MGMT for HAs (benign)

A

fluids, metoclopramide 10 mg IV, analgesic, ketorolac, steroids (dex 10 mg IV); sumatriptans, magnesium, ketamine, propofol

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20
Q

Abdo Pain DDx

A

RUQ: hepatitis, biliary disease, pancreatitis, lung (PNA, PE, pleural effusion), Epigastrium: PUD, gastritis, pancreatitis, ACS; LUQ: pancreatitis, gastritis, PNA/pleural effusion/PE; R flank: kidney, colitis, AAA**; umbilicus: colitis, perforation, obstruction, AD, AAA; L flank: colitis, perforation, obstruction renal colic, pyelonephritis, AAA; RLQ: appendicitis, ectopic, PID/TOA, testicular torsion/epididymytis, orchitis, ovarian torsion, renal colic; hypogastric: UTI, renal colic; LLQ: diverlitulicis, ectopic, PID, TOA, testicular torsion, epididymitis, orchitis, ovarian torsion, renal colic

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21
Q

Can’t Miss Diagnoses for abdo pain

A

ectopic, ruptured AAA, pancreatitis, cholangitis, mesenteric ischemia, obstruction, perforated viscus, complicated diverticulitis

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22
Q

Inv for abdo pain

A

CBC, lytes, Cr, LFT, lipase, lactate, BHCG; abdo ultrasoound/CT, CXR, ECG as needed

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23
Q

MGMT for abdo pain

A

ABCs, NPO, analgesia, consult surgery PRN

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24
Q

Pelvic Pain DDx

A

ruptured cyst, ovarian abscess, ovarian torsion, saplingitis, tubal abscess, hydrosalpinx, PID, endometriosis, fibroids; ectopic, threatened abortion, ovarian hyperstimulation; 2nd trimester: placental abruption, round ligament pain, braxton-hicks contraction; bartholin abscess; urinary

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25
Q

Inv for pelvic pain

A

CBC, lytes, BHCG, +/- swabs; urine, bedside ultrasound

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26
Q

MGMT for PID

A

if severe, admit with IV ABx (cefoxitin 2g IV q6h + doxycycline 100 mg IV q12 x2, then PO); mid-moderate - ceftriaxone 250 IM x1 and doxy 100 mg BID x 14 days

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27
Q

DDx for back pain

A

cauda equina, SCC (spinal mets, epidural abscess, disc hernation, spinal fracture with subluxation), meningitis, vertebral osteomyelitis, transverse myelitis); vascular - AD, ruptured AAA, PE, MI

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28
Q

Red Flags for backpain

A

bowel and bladder dysfunction, anaesthesia, constitutional symptoms, chronic disease, paraesthesia, age > 50, IVDU/infection, neurological deficits

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29
Q

Physical Exam for back pain

A

vitals, pulse deficity, skin for infection/trauma, abdo for AAA, cardiac exam (murmur), MSK, neuro, PVR!

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30
Q

Inv for back pain

A

CBC + ESR/CRP if infectious; bedside ultrasound, PVR (> 200 cc has sensitivity of 90% for CES)

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31
Q

MGMT for Cauda Equina syndrome

A

urgent MRI, spine consult, analgesia, IV dex

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32
Q

MGMT for AD

A

resuscitation, IV labetalol

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33
Q

MGMT for epidural abscess/vertebral osteomyelitis

A

MRI, IV Abx, ortho

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34
Q

Definition of anaphylaxis

A

life-threatening immune hypersensitivity systemic reaction leading to histamine release, vascular permeability and vasodilation

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35
Q

Common triggers for anaphylaxis

A

foods (egg, nut, mlk, fruits), meds, insect bites, aeroallergens

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36
Q

DDx for anaphylaxis

A

shock, angioedema, flush syndrome, asthma exacerbation, red man syndrome

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37
Q

Diagnostic Criteria for Anaphylaxis

A

acute onset (mins-hours) + any of: 1. skin+/-mucsa + respiratory/low BP; 2. exposure to likely allergen(2/4) - skin-mucosal involvement, respiratory difficulties, low BP, GI symptoms 3. low BP after exposure to known allergies

38
Q

Red Man Syndrome

A

anaphylactoid reaction by rapid infusion of vancomycin –> erythematous rash to face, neck, upper torso;

39
Q

Definition of asthma

A

chronic inflammatory airway disease with reversible episodes of bronchospasm and variable airflow obstruction

40
Q

Triggers for asthma

A

URTI, allergens, smoking, exercise

41
Q

Classification of asthma: mild, moderate, severe

A

mild: >95%, SOBOe, chest tightness, expiratory wheeze, FEV1 > 60% predicted; Moderate: SOB at rest, cough, congestion, nocturnal symptoms, >95%, expiratory wheezing, FEV1 40 - 60; severe: agitated, diaphoretic, labored breathing, difficulty speaking; vitals: high HR, high BP, O2 < 95%; exp and inspiratory wheezing, FEV1 < 40%

42
Q

Definition of good asthma control

A

daytime symptoms < 2x/week, no activity limitations, no nocturnal symptoms, rescue puffer < 2/week, normal PFT

43
Q

MGMT of asthma

A

atrovent 0.5 m neb or 4 - 8 puffs q20 mins x 3; ventolin 5 mg neb or 4- 8 puffs via MDI spacer q20mins x 3, prednisone 50 mg PO

44
Q

MGMT of severe asthma

A

2g MgSO2 over 30 mins, epi 0.3 mg IM then 5 mcg/min IV infusion, ketamine with BiPAP, intubate with ketamine + succinylcholine

45
Q

COPD RFs

A

smoking, occupational, chemical exposure

46
Q

COPD triggers

A

URTI, pneumonia, allergens, polluntants, smoking, CHF, PE, MI

47
Q

COPD Sx

A

increasing SOB, sputum production, sputum purulence

48
Q

COPD signs of severity

A

rapid shallow pursed lip breathing, use of accessory muscles, paradxical chest wall movement, central cyanosis, hemodynamic instability

49
Q

MGMT COPD

A

salbutamol 5 mg nes or 4 - 8 puffs MDI q15 mins x 3 PRN; atrovent 0.5 mg nebs or 4 - 8 puffs q15-20mins x 3; steroids: oral prednisone 40 - 60 mg for 5 - 10 days, antibiotics ot 2+ (sputum production/purulence/SOB) like amox, or cephalosporin, CPAP or BiPAP

50
Q

MI Definition

A

myocardial ischemia on spectrum of ACS; diagnosed with cardiac marker abnormalities and 1 of ECG changes, history consistent with ACS

51
Q

Stable Angina definition

A

known history of angina; transient episode of chest discomfort secondary to ischemia precipitated by exertion/emotion, < 15mins, relieved by rest or nitro

52
Q

Unstable Angina definition

A

angina with minimal exertion or at trest or new onset angina or angina post PCI/MI/CABG; worsening change from baseline anginal symptoms, increased duration of pain or threshold, or decreased response of typically effective angina medications

53
Q

STEMI definition

A

ST elevation of 1+ mm/in 2 contiguous leads; V1-V3: 1.5 mm for F, 2.0 for M > 40, 2.5 for M < 40

54
Q

MGMT of STEMI

A

ASA 162 - 325 mg chewed, clopidogrel 300 mg PO or ticagrelor 180 mg PO, antithrombotic: UFH 4000U then 12U/kg, fibrinolytics (enoxaparin); PCI within 90 mins of hospital arrival; lytics < 12 hours of symptoms

55
Q

CHF etiology

A

CAD, HTN, valvular disease, cardiomyopathy, infarction, pericardial disease, myocarditis, cardiac tamponade, metabolic disorder, toxins, congenital

56
Q

CHF triggers

A

cardiac (ischemia, arrhythmias), high CO (anemia, infection, pregnancy, hyperthyroidism), medications (forgot meds, negative inotropes, steroids, NSAIDs), lifestyle (high salt, renal failure, PE, HTN)

57
Q

L-sided symptoms + signs of HF

A

SOB, orthopnea, PND, nocturia, fatigue, altered mental status, pulmoary congestion; hypoxia, crackles, wheezes, S3-S4

58
Q

R-sided symptoms + signs of HF

A

fatigue, abdominal distension, swelling, weight gain; Sx: pitting edema, JVP elevation, hepatosplenomegaly, ascites

59
Q

Inv for HF

A

CBC, lytes, AST, ALT, BUN, Cr, Troponin, BNP, CXR, ECG, POCUS

60
Q

MGMT of HF

A

General, NG 0.4 mg SL q5 mins (if sBP > 100) +/- topical NG patch (0.2 - 0.8 mg/h), furosemide (double home dose); second-line: NTG infusion (10 mcg/min and titrate), if hypotensive, norepi 2 - 12 mcg/min or dobutamine 2.5 mcg/kg/min

61
Q

Causes of Dysrhythmias

A

toxins, ischemia, electrolytes, physical activity (post MI reperfusion), genetic (re-entry)

62
Q

Types of Bradydysrhythmias

A

primary = prolonged PR interval; Mobitz I = gradual PR increase then QRS drop; Mobitz II = PR interval constant with QRS drop; complete = p and QRS are unrelated, constant intervals

63
Q

Types of SVTs

A

Regular: sinus tachycardia, atrial tachycardia, atrial flutter, SVT (AVNRT > AVRT), junctional tachycardia; irregular: a.fib, multifocal atrial tachycardia, SVT with aberrancy

64
Q

Types of ventricular tachydysrhythmias

A

regular: Vtach, SVT with aberrancy; irregular: VFib, polymorphic VT AFib with WPW

65
Q

MGMT for unstable bradycardia

A

atropine 0.5 IV bolus q3-5mis x 6; +/- infusion of dopamine 2 - 10 mcg/kg/min or epi 2-10 mcg/min; transcutaneous pacing if second degree or higher

66
Q

MGMT for unstable tachycardia

A

synchronized cardioversion

67
Q

MGMT of unstable AFib/AFlutter

A

synchronized cardioversion

68
Q

MGMT of unstable VF/pVT

A

epinephrine 1 mg IV q3-5 mins with CPR shocks, amiodarone 300 mg IV bolus with 2nd dose of 150 mg IV

69
Q

ruptured AAA RFs

A

smoking, hypertension, CAD, CTD, DM, FHx

70
Q

Classic triad of AAArupture

A

pulsatile mass, hypotension, acute onset back/abdo/flank pain

71
Q

presentations associated with AAA

A

syncope, UGIB, LGIB, high output HF, ureteral colic, bowel obstruction symptoms

72
Q

Inv for AAA

A

POCUS, ECG, CTA (for stable patients)

73
Q

MGMT for AAA

A

general, resuscitation - aim for sBP of 90 - 100, massive transfusion protocol, urgent surgical intervention

74
Q

Post-op complications of AAA

A

Infection: graft contamination/seeding; Ischemia (spinal cord ischemia, CVA, visceral ischemia), aortoenteric fistula (GI bleeding), endoleak (blood flow outside of graft lumen)

75
Q

Definition of Acute Arterial Occlusion

A

acute emboli or thrombosis causing true emergency due to irreversible damage within 6 -8 hours

76
Q

RFs for acute arterial occlusion

A

atherosclerosis, MI with LV thrombus, AFib, valve stenosis, stents/grafts

77
Q

Signs for Acute Arterial Occlusion

A

6Ps - pain, paresthesia, pallor, polar, pulselessness, paralysis

78
Q

Tests for Acute Arterial Occlusion

A

doppler probe to leg with proximal BP cuff; perfusion pressure < 50 mmHG or ABI < 0.5

79
Q

How to measure ankle brachial index

A

sBP using doppler of DP/PT arteries / brachial arteries (whichever is highest from both arms)

80
Q

MGMT of acute arterial occlusion

A

immediate heparinization with 5000 IU bolus; revacularization vs CT angio

81
Q

normal ABI

A

> 0.9; < 0.5 is severe PAD

82
Q

Well’s Criteria for DVT

A

1 point for any of: active cancer, paralysis/paresis/immobilization of lower limb, bedridden > 3 days or major surgery in 3 months, tenderness along DV system, entire leg swollen, cald swelling > 3 cm, pitting edema on symptomatic leg, previous DVT; -2 if alternative diagnosis; DVT unlikely if 1 or less

83
Q

DVT cut-off for Well’s

A

1 or less: unlikely; 2+: likely; if unlikely, order d-dimer; if DVT likely, order leg doppler

84
Q

Wells Criteria for PE

A

3: for signs and symptoms of DVT, PE is #1 diagnosis 1.5: for tachycardia, immobilization > 3 days or surgery in last month, Hx of DVT/PE, 1: hemoptysis, active cancer

85
Q

Wells Criteria cut-off

A

0 - 4 points: low risk; 4+: high risk; if <4 - order d-dimer, otherwise get CTPA

86
Q

PERC rules qualifiers

A

low-risk patient and low pre-test probability = < 2 % chance of PE; if < 50 yo, HR < 100, SpO2 < 95%, no hemoptysis, no estrogen use, no history of surgery/trauma, no hx of DVT/PE, no signs of DVT

87
Q

PE or DVT MGMT

A

LMWH, DOAC, thrombolysis if unstable/resusication

88
Q

GI bleeding RFs

A

mediations (NSAIDs, anticoagulants), excessive vomiting, bleeding disorder, malignancy, alcohol use, ulcer hx, H.pylori

89
Q

UGIB DDx

A

peptic ulcer disease (gastric > duodenal), gastritis/esophagitis, MW tears, gastric CA

90
Q

LGIB DDx

A

colitis (infectious, ischemic, inflammatory), anorectal pathology, angiodysplasia, diverticulosis, malignancy

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